Need to know: MACRA

This October CMS released the final Medicare Access and CHIP Reauthorization Act (MACRA) rule. MACRA’s Quality Payment Program aims to reduce administrative burden faced by physicians, allowing them to focus on care delivery, promote the shift to value-based medicine, and ensure a smooth transition to this new model of care.

Below are a few FAQ about the MACRA rule and how it might impact your organization.

Q: Who qualifies for the Quality Payment Program?

A: Providers who bill Medicare more than $30,000 a year or provide care for at least 100 Medicare patients qualify for MACRA. This includes physicians, physician assistants, nurse practitioners, clinical nurse specialists and certified registered nurse anesthetists.

Q: When does the Quality Payment Program start?

A: Providers can begin collecting performance data as soon as Jan. 1, 2017. However, CMS is offering providers the option to start anytime between Jan. 1 and Oct. 2. Data is due to CMS by March 31, 2018. The data collected in the first performance year will determine payment adjustments beginning Jan. 1, 2019.

Q: How do providers sign up for MACRA?

A: MACRA has two tracks: MIPS and Advanced APMs. You do not need to sign up for MIPS and can simply report your data during the reporting period. Participants in the Advanced APM track will report through that group. If you do not report by March 31, 2018, you will receive a -4% adjustment in 2019.

Q: Does this just apply to Medicare or is Medicare Advantage included?

A: This program only applies to Medicare Part B.

Q: How will MIPS data be reported?

A: MIPS data for 2017 will be reported by the same methods as the Meaningful Use and PQRS programs. These include claims, registry, QRDC, web interface and/or CMS EHR Incentive Payment Attestation Site.

Q: Is the MACRA/MIPS reporting done the same way as Meaningful Use? Can it be done at the same time?

A: Yes, the reporting options are the same. Because MACRA/MIPS will essentially replace Medicare Meaningful Use beginning in 2017, will not do the reporting at the same time. Your last year for Medicare MU is 2016 and you will report that data by March 31, 2017.

Q: Is the exclusion for less than $30,000 in Medicare claims or 100 patients based on provider or group? For example, if we have two providers, is it for each provider or for the practice as a whole?

A: It is by provider. You will need to determine whether each individual provider meets the exclusion requirements. Your practice may have some providers who are eligible and others are not.

Q: How do you apply for an exclusion to MIPS?

A: This process has not been established yet. The attestation website will likely be modified to allow a provider to indicate their exception.

Q: Is there somewhere we can print lists of the measures and their descriptions?

A: The CMS website has a list of all the measures and their descriptions. It is important to make sure that your EHR has the capability to capture the quality data as all quality data must be entered into a certified EHR, so make sure to ask your EHR vendor if you have any questions about reporting.